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On the Move

by: Tracy Orzel - Monday, October 17, 2016

Interesting fact: I love listening to TED Radio Hour podcasts. I listen to them everywhere—at the gym, in the car…in the car…

So, maybe not everywhere, but I usually listen to at least one a day.

Co-produced by NPR and TED, the TED Radio Hour is based on talks given by expert speakers. Each show is centered on a common theme—sometimes it’s the source of happiness, finding success as an amateur, Maslow’s human needs, or what it means to be afraid—and features sound clips from the original TED talk as well as original interviews with the speaker.

About a month ago I was driving back to Maine from N.J. (a 7-hour car ride) when I listened to a podcast about procrastination, a topic I am sorely familiar with.

The talk was given by Tim Urban, who writes the blog, “Wait But Why,” and it was as if he was speaking directly to me.

Here’s Urban in his own words:


“I wanted to explain to the non-procrastinators of the world what goes on in the heads of procrastinators, and why we are the way we are.

Both brains have a Rational Decision-Maker in them, but the procrastinator's brain also has an Instant Gratification Monkey. 

So the Rational Decision-Maker will make the rational decision to do something productive, but the Monkey doesn't like that plan, so he takes the wheel, and he says, ‘Actually, let's read the entire Wikipedia page of the Nancy Kerrigan/Tonya Harding scandal, because I just remembered that that happened. Then we're going to go over to the fridge, to see if there's anything new in there since 10 minutes ago.’

Now, the Instant Gratification Monkey lives entirely in the present moment. He has no memory of the past, no knowledge of the future, and he only cares about two things: easy and fun.


Which is why we have another guy in our brain: the Rational Decision-Maker, and he just wants us to do whatever makes sense to be doing right now. Sometimes it makes sense to be doing things that are easy and fun, like when you're having dinner or going to bed or enjoying well-earned leisure time. But other times, it makes much more sense to be doing things that are harder and less pleasant, for the sake of the bigger picture. And that's when we have a conflict.

However, it turns out the procrastinator has a guardian angel—someone who's always looking down on him and watching over him in his darkest moments. Someone called the Panic Monster.

Now, the Panic Monster is dormant most of the time, but he suddenly wakes up anytime a deadline gets too close or there's danger of public embarrassment, a career disaster or some other scary consequence. 

And the Monkey—remember, he's terrified of the Panic Monster—boom, he's up the tree! And finally, finally, the Rational Decision-Maker can take the wheel.”


Never in my life have I identified with a metaphor more, which brings us to this blog. 

This morning I realized I haven’t written one in a month and guess who woke up?

by: Tracy Orzel - Thursday, September 8, 2016

I prefer working within the constraints of absolutes (just ask Liz when it comes to firming up layout guidelines for the HME News issues) and often struggle with ambiguity.

Which leads me to politics—a topic I broach with much trepidation. I try to avoid politics when I talk to providers on the phone, because it usually amounts to a lot of soapboxing and a lot of “yups,” “uh-huhs” and “yeahs” from me—whether I agree with the speaker’s view point or not—until I can redirect the conversation back to the topic I called about. However, this is one thing I think we can all agree on.   

Politicians on both sides the aisle LOVE jobs. In fact, I don't know of a politician who doesn't love jobs. They love talking about jobs, they love creating jobs, they love arguing about who loves jobs more.

Yet, this is the No. 1 message from lawmakers and CMS to healthcare providers: STREAMLINE. STREAMLINE. STREAMLINE.

That’s because lawmakers only seem to love jobs when the government doesn’t have to pay people to do the jobs they say they love so much, like respiratory therapists and wheelchair technicians.

I recently spoke to Andrea Ewert, CEO of Home Oxygen Company, who said the company had to lay off “three or four full-time employees and replace them with four or five part-timers” when the second round of cuts took effect on July 1.

In an effort to streamline its business, the company has employed nearly 20 technologies, including Brightree’s document management systems, Strategic AR’s patient receivables software and Apacheta’s mobile solutions. Ewert also uses portable oxygen concentrators (POCs) as her main product line and, as a result, has no need for vans, drivers or deliveries. 

Nowadays, providers need to work more efficiently for less money, and automate any process that can be automated.

I’m not knocking providers who embrace automation—in fact, they can’t afford not to—and I won’t pretend patients don’t benefit from automated processes either.

But lawmakers can’t have it both ways. So, which is it? Jobs or automation?

by: Tracy Orzel - Tuesday, July 12, 2016

"I done fudged up. Bad."

That was the text I sent to Editor Liz this morning. The text was more colorful.

I booked my flight to Washington, D.C. for the CRT conference a week before I took a 7-week sabbatical to walk the Camino de Santiago in Spain. Everything seemed in order and I congratulated myself for being so organized and efficient.

This morning when I arrived at the Portland Jetport at 6:15 for my 7:30 flight, I felt cool and collected. After breezing through security, I moseyed over to the BK Lounge for my customary pre-flight French toast sticks (I get them every time I have a morning flight).

After, I sauntered over to my gate and realized something was amiss. The screen read, "Charlotte, N.C."

"They must have made a mistake," I thought. How embarrassing for them.

I walk (cool as a cucumber) over to the departures board. No flights to Washington, D.C.'s listed there either, at least not in the next hour. Perplexed, I go back over to Gate 10 to talk to the friendly-looking woman behind the American Airlines desk.

"Hi, I think I have the wrong gate. Could you tell me where to go?"

::looks at my boarding pass::

"Oh. I'm sorry. You have the wrong time. This flight is leaving 7:30PM"

::glass shatters in my brain::

Fortunately, she was able to book me on the next flight out, but the shame had already permeated through every cell in my body.

How did I not double check the time before I booked my flight? How did I do this again?!?!?!

Fun fact: When I booked my train from Santiago to Madrid, I forgot that Europe operates on a 24-hour schedule. Imagine my surprise when I realized my 5PM train to Madrid left 12 hours earlier and I had 13 hours to get there before my flight back to the U.S. took off. I got a last-minute flight, but had the plane been full, I would have had to make an impromptu, 8-hour road trip, in a country I am not qualified to drive in. Good times.

The people who correctly booked their flights queuing up for Charlotte, N.C.

Once the gravity of my error completely washed over me, I let it go. Lesson No. 466 I learned on the Camino: You'll get there. It may not be when you planned on getting there or the way you planned on getting there, but you'll get there.

See you in a few hours.

by: Tracy Orzel - Friday, May 13, 2016

I knew it had been a while since my last blog post, but I didn’t realize it’s been a month and a half (sorry, Liz). What’s funny is that it will be at least another month and a half until I write my next one.

Last May, Theresa challenged Liz and I to walk-off in honor of “Get Fit, Don’t Sit” Day, which is held the first Wednesday in May. The plan was the three of us would count our steps for one week. Although last year’s competition fizzled out (rather shamefully), I decided to kick it up a notch this time around by walking across Spain.

OK. We’re not doing a contest this year, but I am taking a leave of absence to walk the Camino de Santiago. Depending on how fast you walk, it takes about a month to finish, but I’m budgeting a little more time for unforeseen circumstances.


(I’m going to be walking the yellow route)


I haven’t planned the fine details of my trip yet, but I’ll be walking about 6 hours every day—which is a little overwhelming, considering the longest amount of time I’ve walked in preparation for this trip is three hours (and that was one time). The first day is usually the hardest, because you have to go over the Pyrenees. Some people bike it, a few still travel on horseback, and others—like Justin Skeesuck—roll. 

When Skeesuck was 16-years-old, a car accident triggered a progressive autoimmune disorder that paralyzed his arms, hands and legs, according to the NY Daily News. In 2012, he saw a TV program about the camino and wondered if he could do it in a wheelchair. Long story short: Yes, yes he could.

It’s easy to tell ourselves we’re too old or too busy to make a big change or do something we've always wanted to do, but that’s just a cover for what we really are: too scared.

The idea of walking 500 miles can be paralyzing (no pun intended), but when you break it down, it's just one step, and then another.  

¡Buen camino!


While I’m gone, you can reach Liz at or Theresa at with any mobility-related news.

by: Tracy Orzel - Friday, April 8, 2016

This morning, Jo Ellen, the HME News sales rep, sent Liz, Theresa and I a very interesting email.  

While she was decluttering her house last night in preparation for an upcoming town-wide paper shredding event, Jo came across a receipt from when she was born in the hospital.

I wasn’t cheeky enough to ask her when exactly that was, but in Jo’s words, “it was decades ago.”


“My mom stayed in the hospital 3 days.

The hospital room and board was $60.00

Medication was $3.65

Doctor was $50.00 to deliver”


Meanwhile, it cost Liz $5,000 (out-of-pocket) to her have baby in the hospital a little over a year-and-a-half-ago.

I used a calculator to figure out the inflation rate, and (assuming I got Jo’s birth year correct) that same hospital stay would have cost this in 2016:


Hospital room and board: $590

Medication: $36

Delivery: $490


In a time when the cost of health care is skyrocketing across the board, rather than unpack this myself, I thought this might provide a little food for thought over the weekend.

by: Tracy Orzel - Friday, March 11, 2016

Theresa came back from Medtrade bearing gifts.

“Want a selfie stick?”


The answer was automatic. I don’t know where I stand on the use of selfie sticks, but as I’ve said before, I love free things so I took it with the enthusiasm of a classically trained hoarder.

As soon as she walked away I took it out of the box and snapped my first selfie stick selfie.


I wondered if I would actually use it in public or if I would feel too self-conscious. I won’t speak for everyone, but I love having my picture taken. If it’s a group photo, I’ll be the first one to ask a friendly-looking stranger to take our photo. And if I can’t find one of those, I’ll ask anyway. So if I’m prepared to interrupt someone’s dinner, why am I so embarrassed to carry a selfie stick?

A few of my friends from college already have them. In an effort to avoid possible shame and ridicule, the first one to consider purchasing one canvased the group for public opinion beforehand.

The support was overwhelming. It turned out that several of the others wanted to buy one for upcoming vacations, but were too embarrassed to admit it.

Me, personally, I haven’t made up my mind about them. On one hand, they’re incredibly convenient—and on the other, I don’t want to look dumb.

As I struggle with this important dilemma, it reminds me of two competing truths (stay with me while I attempt to make a blog about selfie sticks reflect the financial complexities of the HME industry): Reimbursement rates are going down, yet an aging baby boomer generation is on the rise. Some say it’s feast and others say it’s a famine. I think it’s going to be a few more years until we’ve reached a consensus on the industry—and selfie sticks. 

by: Tracy Orzel - Wednesday, February 24, 2016

I love free things. Free samples, free food, free hugs. Free anything. But my favorite freebie? Knowledge.

For example, Harvard offers free online courses through edx. Sure, I may not know the first thing about the nervous system, but that’s not about to stop me from taking “Fundamentals of Neuroscience Part 1: Electrical Properties of the Neuron.”

Actual screenshot from Fundamentals of Neuroscience Part 1: Electrical Properties of the Neuron


I’ll download almost any course/book/how-to, because no matter how obscure or extraneous the content is, if I can gain even just one nugget of practical information to improve myself or expand my mind, it’s worth it. Also, I like getting something for nothing. Feels like I’m beating the system.

But today, I actually downloaded something that actually relates to my job. VGM’s 2016 HME Business Playbook.

I’m going to be honest, I haven’t completely read through it yet (mainly because I’d like to post this blog before Liz notices it’s been more than a week since my last), but from what I’ve looked at so far, it’s pretty easy to digest (which is more than I can say for the Fundamentals of Neuroscience). It highlights trends, business opportunities, cost-savings suggestions, competitive bidding info and reimbursement alternatives, with a whole bunch of nifty graphics—for free!

It can’t be overstated that I have no horses in this race. VGM isn’t paying me to hawk their (free) book—although if interested, I would be happy to set something up offshore. Whether you download it or not, it won’t make a difference to me, but one little nugget of illumination could make a difference to you. 

by: Tracy Orzel - Tuesday, February 16, 2016

Friday was a red-letter day for me and not just because there was birthday cake in the conference room—well, mostly because there was birthday cake in the conference room—but also because our publisher Rick Rector practically gift wrapped me a blog post when I overheard him telling our sales rep Jo-Ellen about the community-wide aging-in-place survey he received in the mail.

Photo taken by Tim Purpura, publisher of Security Systems News, Instagram Filter Master-at-Arms, Grand Sorcerer (first class) 


According to the letter (sent by Yarmouth’s Aging in Place Project), the information gathered will be used to create programs to help Yarmouth seniors stay in their homes longer and make the community more age-friendly as a whole.

Rick gave me the survey to look over and the one question that jumped out to me was, “How likely is it that you will be a Yarmouth resident 10 years from now?”

I’ve written numerous articles extolling the benefits of aging-in-place—from cost savings for families and health systems, to the general happiness and well-being of the patient—but these articles are always written from the provider's/consumer’s POV. When I looked over the survey, I realized there was a third invested party: the community.

When people “age out” of their homes, it’s not just lost tax revenue for the town, it’s an emotional loss. Communities are only as strong as the people living in them, and whenever a member of the tribe leaves, whether to live in an assisted living facility or nursing home, it disturbs the fabric of the neighborhood—of families and friends. Staying in the home doesn’t just improve the health of the patient, it improves the health of the community.

The second thing that struck me about the survey was how forward-thinking it was. Settled in 1636, Yarmouth, Maine is anything but fast-paced, boasting just over 8,000 residents and a small, village atmosphere. While it’s the HME industry’s job to look ahead for aging-in-place trends, it’s nice to see that Yarmouth is looking ahead, too. 

by: Tracy Orzel - Wednesday, January 13, 2016

I like to play a game with Editor Liz to see how long it takes before I post a blog or she reminds me to. I guess it’s more like a race? Hopefully, I’ll win before our editors’ meeting at 2 today.

I have the greatest of intentions. I write down blog ideas as they come to me—after a particularly interesting interview, office joke or life experience—and then I put the paper somewhere “safe.” Invariably, it’s written down on the back of a business card or scratched on the corner of a random print out. That I’ve probably lost. Or thrown away.

In the event our office wins the Powerball tonight, my successor (I’ll be on the first flight out of Portland in search of warmer climes) will find random scraps of scribble hidden in and around my desk area in manner of Emily Dickenson, minus the acclaim.

However, since that’s less likely, I’ve decided to use another ineffective ploy: New Year’s resolutions.

The best part: two birds, one stone—Now I have a blog about blogging more often! Very meta.

As with most of my former resolutions, I’ve announced it in a very public way to invoke shame, lest I go back on my word. 

I’ll let you know how it goes, but hopefully I’ll win the Powerball tonight and we’ll never have to find out. 

by: Tracy Orzel - Wednesday, December 16, 2015

You wouldn’t know it by the 50 degree weather we’ve been enjoying here in Maine, but its actually December, and I’m pleased as punch.

That’s because, barring the occasional rainy and/or hectic workday, I’ve been taking 30-minute walks during my lunch break (or as Liz calls it, “disappearing”) since April.

I think it started when Liz, Theresa and I started a “who-could-accumulate-the-most-steps-in-a-week” competition. Not long after, the challenge fizzled out and there was an unspoken agreement between the three of us that we would never speak of it again.

Even though the walk-off was no more, I continued to “disappear,” taking advantage of the chance to reset my mind and stretch out my legs. Eight months later, my daily outings have become a necessity, rather than a thinly veiled break.

Which is why after writing about Medicaid cuts and access issues for the past 14 months, I am acutely aware of how lucky I am that I can simply stand up, walk down the hall, open the door, take the stairs, and walk—blithely—down the road.

However, that doesn’t mean I couldn’t use a reminder every once and awhile.

This month, I did a Q&A for our upcoming January issue about evidence-based outcome measurements for wheelchair seat cushions. Long story short, the study looked at whether certain cushions could help prevent pressure ulcers and deep tissue deformation in wheelchair users better than others.

Whether it was raining or I had too much work to do, who knows, but I didn’t get my walk in that day and as I wrote up the Q&A I remember feeling sore from sitting in the same position for so long.

That’s when I thought, “I could use one of those cushions right now,” followed by, “What if I used a wheelchair and needed one of those cushions? Would it be covered? What if it wasn’t? Would I have pressure ulcers?” Then I Googled pictures of "pressure ulcers" and got even more upset.  

I realize there’s no way to enforce this, but wouldn’t it be nice if every time Congress failed to pass competitive bidding relief legislation or CMS issued another restrictive rule, those decision makers had to spend an entire day in a basic, no frills, poorly-fitted wheelchair? No shifting. No standing. No walking.

I bet they’d change their tune pretty quickly. I know I would.